Enhanced recovery after surgery: an update for the generalist

To the Editor: The perspective article by Hill and Jin1 provided an update on enhanced recovery after surgery (ERAS), a process of multidisciplinary peri‐operative care with the goal of improving care following surgery. The potential for involving primary care in pre‐operative care was discussed. Most diabetes management occurs in the primary care setting, yet diabetes is a common comorbidity in hospital inpatients. Individuals with diabetes are at risk of harm, with a recent audit of inpatient diabetes care in Queensland finding several deficits in care with high rates of hospital‐acquired complications.2

Acute illness is associated with profound changes in fuel use; the metabolic response varies according to diabetes status,3 and some of the acute changes in metabolism are likely to be modified by some anti‐hyperglycaemic agents.4 Recent improvements in management of diabetes in the ambulatory setting, such as the use of newer pharmacological agents or newer forms of insulin delivery, further increase the complexity of peri‐operative diabetes care. ERAS peri‐operative protocols are likely to be more robust if able to address any gaps in diabetes care between primary and hospital care; and, within the hospital setting, to leverage newer technologies such as virtual glucose management, which has been shown to reduce rates of hospital‐acquired infection.5